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Youth Feedback for Year 2025
Wellbeing.
*
1.
Do you feel that you can control your feelings?
(Required.)
Yes
No
Not sure
*
2.
Do you have Goals?
(Required.)
Yes
No
Not sure
*
3.
Do you make choices for yourself?
(Required.)
Yes
No
Not sure
*
4.
Do you know what you like and don't like?
(Required.)
Yes
No
Not sure
*
5.
Do you have your own things that belong to you?
(Required.)
Yes
No
Not sure
Social Participation.
*
6.
Do you have friends that you like?
(Required.)
Yes
No
Not sure
*
7.
Do you spend time with your family?
(Required.)
Yes
No
Not sure
*
8.
Do you have people in your life that make you feel like you belong?
(Do other people want to do things with you?)
(Required.)
Yes
No
Not sure
*
9.
Do you go out and do things you like with other people (restaurant, movies, etc)?
(Required.)
Yes
No
Not sure
*
10.
Are your rights respected by your staff?
(Required.)
Yes
No
Not sure
*
11.
Do you have other people (not INS) that help you?
(Required.)
Yes
No
Not sure
Independence.
*
12.
Are you happy with your life?
(Required.)
Yes
No
Not sure
*
13.
Can you look after yourself by doing things you know how to do?
(Required.)
Yes
No
Not sure
*
14.
Do you do physical activity like exercise, swimming, walking?
(Required.)
Yes
No
Not sure
*
15.
Do you have good health?
(Required.)
Yes
No
Not sure
*
16.
If you are not in good health, is someone helping you?
(Required.)
Yes
No
Not sure
*
17.
Do you have a safe place to live?
(Required.)
Yes
No
Not sure
*
18.
Are you learning how to do new things?
(Required.)
Yes
No
Not sure
*
19.
Do you feel that you are learning and using Skills?
(Required.)
Yes
No
Not sure
*
20.
Do you like the activities you do?
(Required.)
Yes
No
Not sure
*
21.
Do you go to school or have a job or volunteer work that you like?
(Required.)
Yes
No
Not sure
22.
Check off the ones that apply to you, if any:
Working
Volunteering
School
*
23.
If no, would you like to be in school, working, or volunteering?
(Required.)
Yes
No
Not sure
*
24.
Overall, do you like the support you are getting from INS?
(Required.)
Yes
No
Not sure
*
25.
Is your support available when you need it?
(Required.)
Yes
No
Not sure
*
26.
What would you like to see change about your support?
(Required.)
Contact.
If you would like to be contacted about your survey, please leave your name and phone number.
27.
First name
28.
Last name
29.
Phone number